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Manafi N, Mahmoudi A, Emamverdi M, Corradetti G, Corona ST, Wykoff CC, Sadda SR. Topographic analysis of local OCT biomarkers which predict progression to atrophy in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2024; 262:2083-2091. [PMID: 38300334 PMCID: PMC11222249 DOI: 10.1007/s00417-024-06389-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/10/2024] [Accepted: 01/20/2024] [Indexed: 02/02/2024] Open
Abstract
PURPOSE To define optical coherence tomography (OCT) biomarkers that precede the development of complete retinal pigment epithelium and outer retinal atrophy (cRORA) at that location in eyes with age-related macular degeneration (AMD). METHODS In this retrospective case-control study, patients with dry AMD who had evidence of cRORA and OCT data available for 4 years (48 ± 4 months) prior to the first visit with evidence of cRORA were included. The visit 4 years prior to the development of cRORA was defined as the baseline visit, and the region on the OCT B-scans of future cRORA development was termed the case region. A region in the same eye at the same distance from the foveal center as the case region that did not progress to cRORA was selected as the control region. OCT B-scans at the baseline visit through both the case and control regions were evaluated for the presence of soft and cuticular drusen, drusen with hyporeflective cores (hcD), drusenoid pigment epithelial detachments (PED), subretinal drusenoid deposits (SDD), thick and thin double-layer signs (DLS), intraretinal hyperreflective foci (IHRF), and acquired vitelliform lesions (AVL). RESULTS A total of 57 eyes of 41 patients with dry AMD and evidence of cRORA were included. Mean time from the baseline visit to the first visit with cRORA was 44.7 ± 6.5 months. The presence of soft drusen, drusenoid PED, AVL, thin DLS, and IHRF at the baseline visit was all associated with a significantly increased risk of cRORA at that location. Multivariable logistic regression revealed that IHRF (OR, 8.559; p < 0.001), drusenoid PED (OR, 7.148; p = 0.001), and a thin DLS (OR, 3.483; p = 0.021) were independent predictors of development of cRORA at that location. CONCLUSIONS IHRF, drusenoid PED, and thin DLS are all local risk factors for the development of cRORA at that same location. These findings would support the inclusion of these features within a more granular staging system defining specific steps in the progression from early AMD to atrophy.
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Affiliation(s)
- Navid Manafi
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, 150 N. Orange Grove Blvd, Suite 232, Pasadena, CA, 91103, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Alireza Mahmoudi
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, 150 N. Orange Grove Blvd, Suite 232, Pasadena, CA, 91103, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Mehdi Emamverdi
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, 150 N. Orange Grove Blvd, Suite 232, Pasadena, CA, 91103, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Giulia Corradetti
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, 150 N. Orange Grove Blvd, Suite 232, Pasadena, CA, 91103, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | | | - Charles C Wykoff
- Retina Consultants of Texas, Retina Consultants of America, Houston, TX, USA
| | - SriniVas R Sadda
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, 150 N. Orange Grove Blvd, Suite 232, Pasadena, CA, 91103, USA.
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.
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Curcio CA, Goerdt L. A cell culture system for RPE hypoxia, a physiologic stressor relevant to AMD deposit formation. Eye (Lond) 2024:10.1038/s41433-024-03166-2. [PMID: 38871935 DOI: 10.1038/s41433-024-03166-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024] Open
Affiliation(s)
- Christine A Curcio
- Department of Ophthalmology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Lukas Goerdt
- Department of Ophthalmology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Ophthalmology, University of Bonn, Bonn, Germany
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Kim YH, Yun C, Oh J. Integrity of the Hyperreflective Layer in the Inner Choroid in Eyes with Drusen. Ophthalmol Ther 2024; 13:529-540. [PMID: 38113024 PMCID: PMC10787704 DOI: 10.1007/s40123-023-00865-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION This study aimed to compare the integrity of the hyperreflective layer of the inner choroid in eyes with and without drusen. METHODS Swept-source optical coherence tomography images of patients with drusen and normal controls were reviewed. Using a line plot of ImageJ, choroidal reflectivity was measured at the subfovea, and the integrity of the hyperreflective layer of the inner choroid was determined. RESULTS In total, 63 eyes with drusen and 30 control eyes without drusen were included. The integrity of the hyperreflective layer of the inner choroid was preserved in 81.0% of eyes with drusen and 93.3% of normal controls. The proportion of eyes with the hyperreflective layer did not differ between eyes with and without drusen. Of the 63 subjects with drusen, this hyperreflective layer was observed in all 28 eyes (100%) with pachydrusen but only in 68.6% of the 35 eyes with soft drusen, and its prevalence was significantly different (P = 0.001). CONCLUSION The prevalence of the hyperreflective layer between the choriocapillaris and medium or large choroidal vessels in eyes with soft drusen differed from that in eyes with pachydrusen. These findings support the suggestion that changes within the choroidal stroma may be involved in the pathogenesis of age-related macular degeneration.
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Affiliation(s)
- Young Ho Kim
- Department of Ophthalmology, Korea University College of Medicine, 73 Goryeodae-ro Sungbuk-ku, Seoul, 02841, Korea
| | - Cheolmin Yun
- Department of Ophthalmology, Korea University College of Medicine, 73 Goryeodae-ro Sungbuk-ku, Seoul, 02841, Korea
| | - Jaeryung Oh
- Department of Ophthalmology, Korea University College of Medicine, 73 Goryeodae-ro Sungbuk-ku, Seoul, 02841, Korea.
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Corradetti G, Oncel D, Kadomoto S, Arakaki X, Kloner RA, Sadun AA, Sadda SR, Chan JW. Choriocapillaris and Retinal Vascular Alterations in Presymptomatic Alzheimer's Disease. Invest Ophthalmol Vis Sci 2024; 65:47. [PMID: 38294804 PMCID: PMC10839815 DOI: 10.1167/iovs.65.1.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
Purpose To compare optical coherence tomography angiography (OCTA) retina metrics between cognitively healthy subjects with pathological versus normal cerebrospinal fluid (CSF) Aβ42/tau ratios. Methods Swept-source OCTA scans were collected using the Zeiss PLEX Elite 9000 and analyzed on 23 cognitively healthy (CH) subjects who had previously undergone CSF analysis. Thirteen subjects had a pathological Aβ42/tau (PAT) ratio of <2.7132, indicative of presymptomatic Alzheimer's disease (AD), and 10 had a normal Aβ42/tau (NAT) ratio of ≥2.7132. OCTA en face images of the superficial vascular complex (SVC) and deep vascular complex were binarized and skeletonized to quantify the perfusion density (PD), vessel length density (VLD), and fractal dimension (FrD). The foveal avascular zone (FAZ) area was calculated using the SVC slab. Choriocapillaris flow deficits (CCFDs) were computed from the en face OCTA slab of the CC. The above parameters were compared between CH-PATs and CH-NATs. Results Compared to CH-NATs, CH-PATs showed significantly decreased PD, VLD, and FrD in the SVC, with a significantly increased FAZ area and CCFDs. Conclusions Swept-source OCTA analysis of the SVC and CC suggests a significant vascular loss at the CH stage of pre-AD that might be an indicator of a neurodegenerative process initiated by the impaired clearance of Aβ42 in the blood vessel wall and by phosphorylated tau accumulation in the perivascular spaces, a process that most likely mirrors that in the brain. If confirmed in larger longitudinal studies, OCTA retinal and inner choroidal metrics may be important biomarkers for assessing presymptomatic AD.
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Affiliation(s)
- Giulia Corradetti
- Doheny Eye Institute, Pasadena, California, United States
- Department of Ophthalmology David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - Deniz Oncel
- Doheny Eye Institute, Pasadena, California, United States
| | - Shin Kadomoto
- Doheny Eye Institute, Pasadena, California, United States
| | - Xianghong Arakaki
- Cognition and Brain Integration Laboratory, Department of Neurosciences, Huntington Medical Research Institutes, Pasadena, California, United States
| | - Robert A. Kloner
- Clinical Neuroscience, Department of Neurosciences, Huntington Medical Research Institutes, Pasadena, California, United States
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, California, United States
- Cardiovascular Division, Department of Medicine Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Alfredo A. Sadun
- Doheny Eye Institute, Pasadena, California, United States
- Department of Ophthalmology David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - SriniVas R. Sadda
- Doheny Eye Institute, Pasadena, California, United States
- Department of Ophthalmology David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - Jane W. Chan
- Doheny Eye Institute, Pasadena, California, United States
- Department of Ophthalmology David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
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Abdolrahimzadeh S, Zweifel SA, Di Pippo M, Bajka A, Scuderi G, Lotery AJ. Central macular choriocapillaris impairment as a manifestation of microvascular disease in eyes with subretinal drusenoid deposits. Eye (Lond) 2024; 38:173-178. [PMID: 37419959 PMCID: PMC10764916 DOI: 10.1038/s41433-023-02654-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND/OBJECTIVES Microvascular alterations and choroidal impairment are emerging as a pathologic pathway in age-related macular degeneration (AMD). This study aimed to evaluate the central macular choriocapillaris (CC) in eyes with subretinal drusenoid deposits (SDD) and the retinal microvasculature in patients with early AMD phenotypes. SUBJECTS/METHODS This was an institutional, multicentric observational cross-sectional study. Ninety-nine eyes of 99 subjects; 33 eyes with SDD only, 33 eyes with conventional drusen (CD) only, and 33 eyes of healthy age-matched subjects were included. Comprehensive ophthalmologic examination and optical coherence tomography angiography (OCTA) was performed. The central macular flow area of the CC was analysed in the SDD group and the vessel density of the retinal superficial capillary plexus (SCP) and deep capillary plexus (DCP) was analysed in the SDD and CD groups using automated OCTA output parameters. RESULTS The flow area of the CC in the SDD group was significantly reduced (p ≤ 0.001) with respect to the healthy control group. There was a trend of reduction of vessel density of the SCP and the DCP in the SDD and CD group with respect to controls, although this did not reach statistical significance. CONCLUSIONS OCTA data in the present report corroborate the role of vascular damage in early AMD with CC impairment in the central macular area in eyes with SDD.
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Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy.
- St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy.
| | - Sandrine Anne Zweifel
- Department of Ophthalmology, University Hospital Zurich (USZ), University of Zurich, Zurich, Switzerland
| | - Mariachiara Di Pippo
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Anahita Bajka
- Department of Ophthalmology, University Hospital Zurich (USZ), University of Zurich, Zurich, Switzerland
| | - Gianluca Scuderi
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
- St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Andrew John Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
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Lad EM, Finger RP, Guymer R. Biomarkers for the Progression of Intermediate Age-Related Macular Degeneration. Ophthalmol Ther 2023; 12:2917-2941. [PMID: 37773477 PMCID: PMC10640447 DOI: 10.1007/s40123-023-00807-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/30/2023] [Indexed: 10/01/2023] Open
Abstract
Age-related macular degeneration (AMD) is a leading cause of severe vision loss worldwide, with a global prevalence that is predicted to substantially increase. Identifying early biomarkers indicative of progression risk will improve our ability to assess which patients are at greatest risk of progressing from intermediate AMD (iAMD) to vision-threatening late-stage AMD. This is key to ensuring individualized management and timely intervention before substantial structural damage. Some structural biomarkers suggestive of AMD progression risk are well established, such as changes seen on color fundus photography and more recently optical coherence tomography (drusen volume, pigmentary abnormalities). Emerging biomarkers identified through multimodal imaging, including reticular pseudodrusen, hyperreflective foci, and drusen sub-phenotypes, are being intensively explored as risk factors for progression towards late-stage disease. Other structural biomarkers merit further research, such as ellipsoid zone reflectivity and choriocapillaris flow features. The measures of visual function that best detect change in iAMD and correlate with risk of progression remain under intense investigation, with tests such as dark adaptometry and cone-specific contrast tests being explored. Evidence on blood and plasma markers is preliminary, but there are indications that changes in levels of C-reactive protein and high-density lipoprotein cholesterol may be used to stratify patients and predict risk. With further research, some of these biomarkers may be used to monitor progression. Emerging artificial intelligence methods may help evaluate and validate these biomarkers; however, until we have large and well-curated longitudinal data sets, using artificial intelligence effectively to inform clinical trial design and detect outcomes will remain challenging. This is an exciting area of intense research, and further work is needed to establish the most promising biomarkers for disease progression and their use in clinical care and future trials. Ultimately, a multimodal approach may yield the most accurate means of monitoring and predicting future progression towards vision-threatening, late-stage AMD.
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Affiliation(s)
- Eleonora M Lad
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA.
| | - Robert P Finger
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Robyn Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
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7
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Fogel Levin M, Santina A, Corradetti G, Au A, Lu A, Abraham N, Somisetty S, Romero Morales V, Wong A, Sadda S, Sarraf D. Pentosan Polysulfate Sodium-Associated Maculopathy: Early Detection Using OCT Angiography and Choriocapillaris Flow Deficit Analysis. Am J Ophthalmol 2022; 244:38-47. [PMID: 35901995 DOI: 10.1016/j.ajo.2022.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To compare choriocapillaris flow deficit (CC-FD) analysis using optical coherence tomography angiography (OCTA) in eyes of patients treated with high cumulative dosages of pentosan polysulfate sodium (PPS) but no signs of retinal toxicity versus healthy age-matched controls. DESIGN Retrospective clinical cohort study. METHODS Patients treated with PPS for interstitial cystitis with a cumulative dose of > 1000 g underwent multimodal imaging screening to exclude evidence of PPS maculopathy or other retinal findings. All study patients and age-matched healthy controls completed a 3 × 3 mm macular volume scan OCTA using the SOLIX full-range OCT. En face OCTA images at the level of the CC were exported and CC-FDs were computed and compared between groups. RESULTS Fifteen patients treated with PPS and 15 age-matched controls were included. The mean PPS cumulative dose was 1974 ± 666 g over a mean of 17.6 ± 6.8 treatment years. All patients registered a visual acuity of 20/25 or better and normal fundus autofluorescence (FAF), OCT, multicolor, near-infrared reflectance (NIR), and ultra-widefield fundus color and autofluorescence images. The CC-FD was 32.7 ± 3.6% in the PPS group compared with 28.6 ± 4.3% in the control group (P = .023). CONCLUSIONS Patients treated with PPS long enough to accumulate dosages > 1000 g showed significant CC flow impairment before the development of macular toxicity signs with OCT, NIR, and FAF compared with age-matched normal controls. Thus, the choroid may be the earliest manifestation of ocular toxicity, predating the development of clinically evident retinal pigment epithelium (RPE) injury. The subsequent RPE disruption may be the result of choriocapillaris impairment or primary PPS toxicity. Assessment of the CC on OCTA may be a useful tool for early detection of toxicity, although further longitudinal studies are required.
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Affiliation(s)
- Meira Fogel Levin
- Stein Eye Institute, University of California-Los Angeles School of Medicine, Los Angeles, USA (M.F.L, A.S, G.C, A.A, A.L, N.A, S.S, V.R.M, A.W, D.S)
| | - Ahmad Santina
- Stein Eye Institute, University of California-Los Angeles School of Medicine, Los Angeles, USA (M.F.L, A.S, G.C, A.A, A.L, N.A, S.S, V.R.M, A.W, D.S)
| | - Giulia Corradetti
- Stein Eye Institute, University of California-Los Angeles School of Medicine, Los Angeles, USA (M.F.L, A.S, G.C, A.A, A.L, N.A, S.S, V.R.M, A.W, D.S); Doheny Eye Institute, Los Angeles, California, USA (G.C, S.V.S)
| | - Adrian Au
- Stein Eye Institute, University of California-Los Angeles School of Medicine, Los Angeles, USA (M.F.L, A.S, G.C, A.A, A.L, N.A, S.S, V.R.M, A.W, D.S)
| | - Anthony Lu
- Stein Eye Institute, University of California-Los Angeles School of Medicine, Los Angeles, USA (M.F.L, A.S, G.C, A.A, A.L, N.A, S.S, V.R.M, A.W, D.S)
| | - Neda Abraham
- Stein Eye Institute, University of California-Los Angeles School of Medicine, Los Angeles, USA (M.F.L, A.S, G.C, A.A, A.L, N.A, S.S, V.R.M, A.W, D.S)
| | - Swathi Somisetty
- Stein Eye Institute, University of California-Los Angeles School of Medicine, Los Angeles, USA (M.F.L, A.S, G.C, A.A, A.L, N.A, S.S, V.R.M, A.W, D.S)
| | - Veronica Romero Morales
- Stein Eye Institute, University of California-Los Angeles School of Medicine, Los Angeles, USA (M.F.L, A.S, G.C, A.A, A.L, N.A, S.S, V.R.M, A.W, D.S)
| | - Alice Wong
- Stein Eye Institute, University of California-Los Angeles School of Medicine, Los Angeles, USA (M.F.L, A.S, G.C, A.A, A.L, N.A, S.S, V.R.M, A.W, D.S)
| | - SriniVas Sadda
- Doheny Eye Institute, Los Angeles, California, USA (G.C, S.V.S); Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA (S.V.S)
| | - David Sarraf
- Stein Eye Institute, University of California-Los Angeles School of Medicine, Los Angeles, USA (M.F.L, A.S, G.C, A.A, A.L, N.A, S.S, V.R.M, A.W, D.S); Greater Los Angeles VA Healthcare Center, Los Angeles, California, USA (D.S).
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Savastano MC, Fossataro C, Carlà MM, Fantozzi C, Falsini B, Savastano A, Rizzo C, Kilian R, Rizzo S. OCT angiography analysis of choriocapillaris vascular density in different stages of age-related macular degeneration. FRONTIERS IN OPHTHALMOLOGY 2022; 2:985262. [PMID: 38983525 PMCID: PMC11182125 DOI: 10.3389/fopht.2022.985262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/23/2022] [Indexed: 07/11/2024]
Abstract
Objectives To analyze the choriocapillaris vessel density (CVD) of eyes at different stages of Age-related Macular Degeneration (AMD) with Optical Coherence Tomography Angiography (OCTA). Methods This is a prospective observational cross-sectional study on 21 age-matched healthy eyes and 84 eyes with AMD (i.e., early AMD, late AMD, Geographic Atrophy [GA], and disciform scar AMD). OCTA was used to automatically measure the CVD (%), on both the whole macula and the foveal area, in a layer going from 9 µm above to 30 µm below the Bruch's membrane. Furthermore, in the GA subgroup, the extension of the Ellipsoid Zone (EZ) interruption and the area of macular chorio-retinal atrophy was analyzed. Results Macular CVD was significantly lower in the GA, late AMD and disciform scar AMD-subgroups compared to controls (respectively, p=0.0052; p<0.0001; p=0.0003), whereas it did not significantly vary in the early AMD group (p=0.86). A significant difference between the early AMD and both the late AMD and the disciform scar AMD subgroups was also found (p=0.0009 and 0.0095, respectively). When comparing the foveal CVD of healthy and AMD eyes, a significant difference was found with every AMD subgroup (early AMD, p=0.011; GA, p<0.0001; late AMD, p<0.0001; disciform scar AMD, p<0.0001). Furthermore, in the GA subgroup, the CVD had an inverse correlation with both the extension of the EZ-interruption (p=0.012) and with the calculated chorio-retinal atrophic area (p=0.009). Conclusions OCTA could play a crucial role in the categorization of AMD, allowing for the evaluation of gradual flow impairment at different stages of the disease. Moreover, the detection of a decreased macular and foveal CVD may shed light on the pathogenesis of AMD.
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Affiliation(s)
- Maria Cristina Savastano
- Ophthalmology Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
- Ophthalmology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudia Fossataro
- Ophthalmology Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
- Ophthalmology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
- Ophthalmology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Fantozzi
- Ophthalmology Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
- Ophthalmology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Benedetto Falsini
- Ophthalmology Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
- Ophthalmology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfonso Savastano
- Ophthalmology Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
- Ophthalmology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Clara Rizzo
- Ophthalmology Unit, University of Verona, Verona, Italy
| | | | - Stanislao Rizzo
- Ophthalmology Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
- Ophthalmology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
- Consiglio Nazionale della Ricerca (CNR), Istituto di Neuroscienze, Pisa, Italy
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